Dermoscopy was primarily used for the early diagnosis of melanoma and precursors in former times; in recent years, dermoscopy has proven itself as a useful non-invasive tool for aiding in diagnosis, differential diagnosis, prognosis and evaluating treatment efficacy in the cases of melasma.

It provides additional information at a sub-macroscopic level that may help the dermatologist tell apart between melasma and few other conditions that are hardly discernible with the naked eye. The criteria to be considered when using dermoscopy are: (1) the morphology/arrangement of vascular structures, (2) pigment depth and arrangement and (3) specific clues.[1] Dermoscopic findings must be inferred within the overall clinical setting of the patient (personal/family history, number, location, morphology and distribution of the lesions, etc.) because only the combination between such data can really boost the diagnostic precision.[2] In fact, even though it has been demonstrated that there are some ‘specific’ dermoscopic criteria, there are sometimes, just ‘non-specific’ findings, which may be considered useful only if coupled with proper and accurate clinical and anamnestic information.[1],[2]

Another crucial factor that must be taken into account in dermoscopic examination is the choice of the equipment. In particular, polarised light non-contact dermoscopy is usually preferred over conventional non-polarised light contact dermoscopy because the latter may reduce the vessels’ (due to pressure) visibility, even though some clues are better seen with non-polarised light devices (i.e. more superficial findings).[1],[3]

The purpose of this article is to provide a brief insight into the use of dermoscopy in melasma. Not all cases of melasma require dermoscopy as a screening test. It should be reserved for cases where it is difficult to differentiate from other causes of facial pigmentation such as lichen planus pigmentosus, pigmented contact dermatitis or exogenous ochronosis for that matter. When confused between melasma and exogenous ochronosis, dermoscopy should be used when patients have the history of chronic hydroquinone usage, there the facial hyperpigmentation is not responding to treatment or facial hyperpigmentation relapsing after initial improvement, coarse texture of the skin on palpation, presence of fine telangiectasia’s or hyperchromia with ‘speckling’ or ‘reticulation’.[4]

Dermoscopic findings of lichen planus pigmentosus are exactly different from melasma. The main dermoscopic patterns of lichen planus pigmentosus are represented by a diffuse, structureless, brownish pigmentation and/or fine/coarse, grey-blue/brown dots/globules; perifollicular/annular pigmentation, and white dots are other less common findings.[7]

Apart from helping in diagnosis in difficult cases, dermoscopy can be used as a baseline test before starting treatment which can predict prognosis based on the depth of the pigment and can also be used during follow-up visits to see the response to the treatment.

In cases of exogenous ochronosis co-existing with melasma, it can be useful for site selection for skin biopsy for confirming the diagnosis because treatment is entirely different for the two disorders.

To conclude, while currently dermoscopy may not be used diligently in all the cases of melasma, in the near future, it might become a part and parcel of melasma treatment in all dermatologic settings because of its usefulness and convenience in diagnosing and prognosticating difficult cases of melasma.